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• HMSA Medicare Advantage Disenrollment Request Form

  This form is for current HMSA Medicare Advantage members who want to disenroll from Akamai Advantage.

• Essential, Optimal, and Metallic Formulary Coverage Determination Request

  Need a prescription drug that’s not on your formulary? Get instructions on how to start the request process with your doctor.

• Dental Appeals

  You can ask us to recheck a decision about your health plan or prescription drug coverage for services or benefits you've received.

• QUEST Integration Formulary Exception Request

  Need a prescription drug that's not on your formulary? Get instructions on how to start the request process with your doctor.

• Request For Insurance Commissioner External Review

  You can ask to have an independent review organization look over your appeal if you think we made a mistake.

• Commercial Member Form to Appeal

  You can ask us to recheck a decision about your health plan or prescription drug coverage for services or benefits you've received.

• HSTA Travel Reimbursement Benefit Request Form

  Find out if you qualify for HSTA travel reimbursement by filling out this form.

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